Ray Croucher

Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children

This ecological study investigated the associations between social deprivation, income inequality and social cohesion and dental caries levels in school children of the Distrito Federal, Brazil. Three sources of data were used: (1) area-based data from a 1997 social survey carried out on 13,000 families, (2) 1995 census data collected for the Government of the Distrito Federal (GDF), and (3) dental caries data from a 1997 oral health survey on 7296 6-12-year-old school children. Results of simple linear regression showed that percent with less than eight years of education (P = 0.03) and percent who did not have a maid (P = 0.009), were negatively statistically significantly associated with the percent of children free of caries. None of the deprivation measures were statistically significantly associated with mean DMF-T scores (P > 0.05). GINI coefficient, an indicator of social inequalities, was negatively statistically significantly associated with both measures of dental caries experience, percent of caries free (P = 0.003) and mean DMF-T scores (P = 0.01). Per thousand number of homicides or attempted homicides, an indicator of social cohesion was of marginal statistical significance associated with caries experience. Results of multiple linear regression analyses showed that only the Gini coefficient remained statistically significantly associated with both dental clinical measures used, after adjusting for potential confounding. In conclusion, relative rather than absolute levels of income were stronger determinants of the onset of caries in this study.

Emotional intelligence and stress coping in dental undergraduates — a qualitative study

Objective: To explore how dental undergraduates with different levels of emotional intelligence (EI) cope with stress.Design: Qualitative unstructured depth interviews.Setting: A dental teaching hospital in the UK, 2002.Subjects and Methods: Subjects selected from the undergraduate population of a 5-year dental degree course. A questionnaire survey was carried out to determine the EI scores of the subjects. In each year of study, subjects were divided into low and high EI groups at the median score. From each EI group in each year, one male and one female subject were recruited. Data collection Unstructured face-to-face interviews. Data analysis Transcribing, sifting, indexing and charting data according to key themes.Results: 10 males and 10 females with low and high EI, representing all 5 years of study were interviewed. The experience of stress, expressed in emotional terms, ranged from anger and frustration to hatred. Four sets of coping strategies, adopted at varying degrees according to EI, were identified. High EI students were more likely to adopt reflection and appraisal, social and interpersonal, and organisation and time-management skills. Low EI students were more likely to engage in health-damaging behaviours.Conclusions: Future research needs to establish whether the enhancement of EI in dental students would lead to improved stress-coping, and better physical and psychological health.

Tobacco dependence in a UK Bangladeshi female population: a cross-sectional study.

The objective of this study was to establish the prevalence of paan chewing with tobacco by UK-resident Bangladeshi women and the extent to which they manifest nicotine dependence. The cross-sectional study was conducted at two local authority housing estates in Tower Hamlets, London. Participants were 242 Bangladeshi women, selected at random from the current electoral register, who supplied a saliva sample for cotinine and an expired air sample for carbon monoxide analysis. They also participated in a structured interview assessing knowledge, attitudes and behavior with respect to tobacco use. Main outcome measures were data on tobacco use and nicotine dependence, assessed by questionnaire and intake measures. The population prevalence of chewing paan quid with tobacco was 48.5% (95% confidence interval, CI 42.01-54.98%), while 4% (95% CI 2.05-7.41%) smoked cigarettes. Higher mean salivary cotinine scores were associated with greater consumption frequency and use of leaf tobacco in the quid. Above-average nicotine dependence was associated with chewing paan quid with tobacco within 1 h of waking (OR = 4.02, p = 0.03, 95% CI 1.08-14.94) and the use of leaf rather than processed tobacco (OR = 3.91, p = 0.025, 95% CI 1.19-12.81). Smoking prevalence is low, but the prevalence of paan quid with tobacco chewing is high in this sample of Bangladeshi women. Cotinine concentration appears to be a reliable indicator of levels of nicotine dependence among paan quid with tobacco chewers. Questionnaire-derived items can be used to identify those with above-average levels of nicotine dependence.

Correlates of Nicotine Dependence in U.K. Resident Yemeni Khat Chewers: A Cross-Sectional Study

INTRODUCTION Khat chewing is often associated with tobacco use with impacts on health. This cross-sectional study aimed (a) to explore and validate aspects of self-reported tobacco smoking and whether objective measures of tobacco smoking differ in different situations among khat chewers who smoked and (b) to assess the social factors correlated with nicotine dependence among khat chewers who smoked regularly. METHODS This study recruited a purposive sample of 204 U.K. resident Yemeni khat chewers during random visits to Khat sale outlets. Data were collected via a face-to-face scheduled interview. Data analyses included descriptive tests and a hierarchical linear multiple regression. RESULTS Of 133 self-reported tobacco smokers, 68% were regular smokers with a mean (SD) carbon monoxide (CO) score (20.53 ± 12.12 ppm) and 32% were episodic smokers with a mean (SD) CO score (16 ± 15.66 ppm). Tobacco smoking as an enhancement of the impacts of khat chewing was reported by 65% and 69% of regular and episodic smokers, respectively. In both groups, higher CO scores were recorded during khat chewing. Hierarchical linear multiple regression modeling showed that increases in levels of severity of dependence on khat chewing were correlated positively with increase in levels of nicotine dependence (β = .27, p = .006, 95% CI = 0.05, 0.29), whereas social participation was correlated inversely (β = -.34, p = .001, 95% CI = -0.06, -0.02). CONCLUSIONS In this study, smoking prevalence was high. Smoking increased during khat chewing. Nicotine dependence levels correlated positively with khat dependence levels, while higher social participation reduced nicotine dependence.

Activities related to the occurrence of traumatic dental injuries in 15- to 18-year-olds.

OBJECTIVE To assess the activities related to the occurrence of traumatic dental injuries (TDI) in order to establish the relationship between gender, socio-economic status (SES) and major TDI related events, using classification and examination procedures suitable for epidemiological purposes, in a sample of 15- to 18-year-old students in Taiwan. METHODS A random sample of 6312 15- to 18-year-old senior high school students in southern Taiwan was selected. Each was examined with standard clinical procedures and a questionnaire. RESULTS The prevalence of TDI was 19.9%. The major TDI related events included sports and leisure activities (30.8%), eating (20.5%), falls (19.4%), traffic accidents (10.2%) and collisions (7.1%). Within TDI victims, sports and leisure related TDI were more prevalent among males (P = 0.001, OR = 1.640, 95% CI = 1.225, 2.195) and high SES adolescents (P = 0.014, OR = 1.991, 95% CI = 1.149, 3.449). The occurrence of non-accidental TDI was not related to age, gender and SES (P > or = 0.643). CONCLUSION Traumatic dental injuries have become an important issue in public health and dentistry. Prevention and treatment of TDI should be emphasised to the public, the health professional and the policy maker. Future investigations into the relationship between TDI related events and their determinants are indicated.

Accessibility of chewing tobacco products in England

BACKGROUND The carcinogenicity of chewing tobacco is well established. It is predominantly used by the South Asian community in England. Little is known about the accessibility of the products available for use in England. METHODS Wards with high proportions or numbers of residents from the South Asian community were identified using 2001 Census data. Within each ward product purchasers identified retail outlets and purchased chewing tobacco products from them. RESULTS Chewing tobacco products were found in a broad variety of premises in all but one ward, and were easily accessible. Ninety-eight products were identified and purchased with a mean price of pound1.82. Of the ninety four pre-packaged products purchased only 15% (95% CI: 8%, 22%) complied with legal health warning requirements. CONCLUSION The study indicates the need to improve compliance with legal controls and enforcement to protect the South Asian community from health risks associated with chewing tobacco products.

Treatment planning: Perceived inability to cope and care-seeking in patients with toothache: a qualitative study

Aims To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache.Materials and methods Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes.Findings A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists.Conclusions The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.

Development and validation of a dental pain-screening questionnaire

Abstract Dental pain, estimated to affect 12–40% of community‐dwelling adults, is a symptom of a wide range of clinical conditions. A population screening instrument is needed to study their prevalence. This project aimed to develop a questionnaire for classifying a sample of dental pain patients into three groups of common dental pain conditions, i.e. Group 1 (Acute periapical periodontitis and Irreversible pulpitis), Group 2 (Reversible pulpitis and Dentine hypersensitivity) and Group 3 (Pericoronitis). Initial items were generated through a literature review, individual unstructured patient interviews and consultation with experts. Items generated were administered to a sample of dental pain patients for self‐completion. Responses were subjected to a series of factor and discriminant analyses to identify questions capable of differentiating the sample into three groups, originally categorized by clinical diagnosis, with high classification rates. The selected items were administered to a further sample of dental pain patients to test for its sensitivity and specificity in classifying the sample into three groups against the gold standard of clinical diagnosis. The final 16‐item Dental Pain Questionnaire (DePaQ) was capable of correctly classifying 89.7% of dental pain cases initially categorized by clinical diagnoses. The sensitivity of the questionnaire was 0.80—Group1, 0.85—Group2 and 0.59—Group3. Specificity was 0.83—Group1, 0.89—Group2 and 0.90—Group3. The DePaQ, which can easily be administered by non‐clinical personnel, may be used to collect epidemiological data on common dental pain conditions, assess dental needs for a specified population, and triage of patients seeking treatment for dental pain.

Bangladeshi Dental Students’ Knowledge, Attitudes and Behaviour Regarding Tobacco Control and Oral Cancer

Bangladesh’s oral cancer incidence is high. Dentists can participate in tobacco control. The aim of this study is to explore tobacco use, tobacco control attitudes and oral cancer knowledge among Bangladeshi dental undergraduates. This cross-sectional study used the Global Health Professional Students Survey and the Humphris Oral Cancer Knowledge Scale. One hundred eighty six questionnaires were analysed, a 79% response rate. Tobacco use, oral cancer knowledge, attitudes towards tobacco control and the dentist’s role in tobacco cessation varied significantly between colleges and by gender. Oral cancer knowledge and positive tobacco control attitudes did not influence tobacco use. There is a global problem in preparing dental students for a holistic, integrated approach to oral cancer prevention.

Tobacco Promotion and Availability in School Neighborhoods in India: a Cross-sectional Study of their Impact on Adolescent Tobacco Use

BACKGROUND Adolescent tobacco use is a major public health problem. However, there is little information about the impact of tobacco advertising and availability near schools on adolescent tobacco use in India. METHODS The various tobacco products and brands available in outlets within 100 meters of two high schools in an Indian town were identified. A stratified random sample of 172 participants from these two schools completed a questionnaire on tobacco use and socioeconomic status. RESULTS Eighteen outlets selling tobacco products were identified. In the two schools the current use of smoked and smokeless tobacco was 9.1% and 17.4% respectively. School location and low socio-economic status of adolescents were associated with tobacco awareness of advertisements (p=0.001) and the receipt of a free sample (p= 0.032). Advertisements on billboards, posters and the receipt of a free tobacco sample were significant factors (p=0.031, p=0.016, p=0.017 respectively) in current tobacco use. CONCLUSION In this study a significant proportion of adolescents used tobacco. Tobacco- promotion activities (advertising, the receipt of a free sample), school location and economic status were found to be associated with adolescent tobacco initiation. The local environment should be included in the prevention of adolescent tobacco initiation.